In 1979 Singer and Blom(1) described an endoscopic technique for voice rehabilitation following laryngectomy which involves the placement of a controlled midline tracheoesophageal puncture. Forty-eight hours postoperatively the puncture is sten with a removeable one-way valve to eliminate aspiration. Voice is produced by occluding the tracheostoma with a finger to divert exhaled air through the valved prosthesis into the esophagus. In most instances fluent speech is achieved within one to four days following insertion of the valve. Over the past three years Singer and Blom(2) have achieved fluent voice in 88% of 175 patients with minimal complications. These results have been replicated by other investigators(3,4,5). Published reports have been based primarily on subjective clinical impressions. This prospective investigation is designed to objectively document the efficacy of the tracheoesophageal puncture technique. Detailed observations and measurements will be recorded on all patients who undergo this techniques at the Methodist Hospital of Indiana, Inc., during the first year of this investigation (approximately 50 patients). The following seven parameters will be studied; 1) level of alaryngeal speech proficiency i.e., acceptability, intelligibility, prior to surgical voice rehabilitation 2) level of tracheoesophageal speech proficiency 4 days, post surgery and insertion of the voice prosthesis 3) validity of the preoperative esophageal distention test in predicting postoperative voice acquisition 4) elimination of aspiration with the valved prosthesis 5) complications associated with surgical voice rehabilitation 6) cost effectiveness 7) adequacy of a self-closing respiratory valve designed to eliminate manual occlusion of the tracheostoma during speech. During the second year of this investigation each patient's video taped speech samples will be judged for acceptability (effectiveness) by 100 listeners unfamiliar with alaryngeal speech. Listeners will also rate speech intelligibility. Normative data derived from this investigation, when compared to existing observations of esophageal speech, will provide a basis for efficacy comparisons.